Covid Screening

Please complete on the SAME day as your practice, up until 1 hour before!

Without completion, you do not participate!

Please give your full name

Associations Name

What Level

Do you have a fever?

Do you have a cough?

Do you have shortness of breathe/difficulty breathing?

Do you have a runny nose?

Do you have a sore throat?

Do you have chills?

Do you have pain when you swallow?

Do you have nasal congestion?

Do you feel fatigued/unwell?

Are you experiencing nausea/vomiting/diarrhea?

Do you have unexplained loss of appetite?

Loss of sense of taste or smell?

Do your muscles/joints ache?

Do you have a headache?

Do you have conjunctivitis (pink eye)?

Have you bee outside Canada in the last 14 days?

Have you been in close contact with someone who has tested positive in the last 14 days?